Neuropathic ocular pain: an important yet underevaluated feature of dry eye

Abstract

Dry eye has gained recognition as a public health problem given its prevalence, morbidity, and cost implications. Dry eye can have a variety of symptoms including blurred vision, irritation, and ocular pain. Within dry eyeassociated ocular pain, some patients report transient pain whereas others complain of chronic pain. In this review, we will summarize the evidence that chronicity is more likely to occur in patients with dysfunction in their ocular sensory apparatus (ie, neuropathic ocular pain). Clinical evidence of dysfunction includes the presence of spontaneous dysesthesias, allodynia, hyperalgesia, and corneal nerve morphologic and functional abnormalities. Both peripheral and central sensitizations likely play a role in generating the noted clinical characteristics. We will further discuss how evaluating for neuropathic ocular pain may affect the treatment of dry eye-associated chronic pain.

Dry Eye-Related Visual Blurring and Irritative Symptoms and Their Association with Depression and Anxiety in Eye Clinic Patients

“…48 It is noteworthy that depression was not related to tear secretion in Sjogren's syndrome patients. 49 There is a plausible explanation as to why symptoms of depression are associated with visual blurring rather than irritation: chronic neuropathic ocular pain is associated with dry eye 50 and inflammation in trigeminal neuropathy, such as from herpes zoster, has been linked to depression. 51 However, symptoms of irritation can affect patients in different ways, depending on their personality and other confounding factors.…”

Electrical Stimulation of the Trigeminal Ganglion and Intrathecal Drug Delivery Systems for the Management of Corneal Neuropathic Pain

“…[3][4][5][6] These symptoms rarely respond to traditional dry eye therapy or systemic therapy. 7 We report a case of corneal neuropathic pain resistant to both ocular and systemic therapies that was successfully managed surgically using electrical stimulation of the trigeminal ganglion and implantation of a high cervical intrathecal infusion system.…”

Cyclosporine in ocular surface inflammation

“…Assessing and treating corneal neuropathy in DED is likely to be more important when considering our treatment options. 13 Use in adenoviral keratitis: reduction on subepithelial infiltrates? Adenoviral keratitis can be visually debilitating, both in the acute phase when there pseudomomembrane formation or later there is corneal involvement with subepithelial inflammatory infiltration.…”

“…The discomfort can lead to the development of psychosocial problems such as depression, stress, anxiety, and sleep disorders. 13 We currently do not assess the presence of neuropathic ocular pain in DED. We often fail to consider this possibility.…”

“…13 Pain can originate from both nociceptive and neuropathic sources. DED patients often describe features of neuropathic pain, which include spontaneous pain, dysesthesias (unpleasant abnormal sensations), and hyperalgesia (exaggerated pain response to supra-threshold noxious stimuli).…”